Healthcare Provider Details

I. General information

NPI: 1134141682
Provider Name (Legal Business Name): HOT SPRINGS PEDIATRIC CLINIC,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 MALVERN AVE
HOT SPRINGS AR
71901-7752
US

IV. Provider business mailing address

1920 MALVERN AVE
HOT SPRINGS AR
71901-7752
US

V. Phone/Fax

Practice location:
  • Phone: 501-321-1314
  • Fax: 501-321-1810
Mailing address:
  • Phone: 501-321-1314
  • Fax: 510-321-1810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberA02978
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-2525
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-3838
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-4451
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-7142
License Number StateAR
# 6
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberA02978ANP
License Number StateAR
# 7
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR-4078
License Number StateAR

VIII. Authorized Official

Name: MS. JANA MARIE MARTIN
Title or Position: OWNER
Credential: M.D.
Phone: 501-321-1314